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Northeastern Vermont Regional Hospital, Inc

Organization Active NPI Rural Health Clinic/Center · St Johnsbury, VT

NPI 1831132299 · NPPES record last updated Feb 11, 2020

Key facts

NPI
1831132299
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Practice address
1315 Hospital Dr
St Johnsbury, VT 05819-9210
Phone
(802) 748-7300
Fax
(802) 748-7321
NPI assigned
Jun 14, 2006
Organization subpart
No

Authorized official

Name
Robert N Hersey
Title
Cfo
Phone
(802) 748-7520

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 112

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 112

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in VT

Rural health clinic certification: CCN 473992

Legal name
NORTHEASTERN VERMONT REGIONAL HOSPITAL INC
Doing business as
NVRH WOMENS WELLNESS CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 4, 2014
Last certification
Apr 4, 2014
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Jun 1, 1964 in VT
Enrollment address
1315 Hospital Dr
Saint Johnsbury, VT 05819-9210
Related CCNs
471303

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert N Hersey
Individual 		Corporate Officer
Cfo		 Oct 1, 1999
W-2 Managing Employee Sep 1, 1999
Shawn Patrick Tester
Individual 		Corporate Officer
Ceo		 Dec 31, 2018
W-2 Managing Employee
Ceo		 Dec 31, 2018
Andre Bissonnette
Individual 		Corporate Officer
Chief Financial Officer		 Jul 15, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20060324000349 VT Part B Supplier - Clinic/Group Practice 3678481405 Receives reassigned benefits from 22 practitioners
Practice locations: Saint Johnsbury, VT
O20130823000063 VT Part a Provider - Rural Health Clinic 3678481405 Practice locations: Saint Johnsbury, VT

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207V00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

1315 Hospital Dr
St Johnsbury, VT 05819-9210

Mailing address

PO Box 905
St Johnsbury, VT 05819-0905
Phone (802) 748-8141

Other identifiers

IdentifierTypeStateIssuer
1004830MedicaidVT
0473992MedicaidVT
3076798MedicaidNH

Other names

  • NVRH Womens Wellness Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 11, 2020.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1831132299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 905",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058190905",
            "telephone_number": "802-748-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 HOSPITAL DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199210",
            "telephone_number": "802-748-7300",
            "fax_number": "802-748-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "HERSEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-748-7520"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004830",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0473992",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3076798",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NVRH Womens Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NVRH Womens Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johnsbury, VT

All providers in St Johnsbury, VT · Rural Health Clinic/Center in Vermont

Sources for this page

Verify at the official NPI Registry.